I've put together seven tips to help you prevent a medical malpractice mishap. As with anything, to avoid a suit trust your gut and listen to your instincts.

1. Practice safe and quality patient care. You have a legal and moral obligation to offer your patient the highest standard of treatment from the moment of contact. If you adopt the mindset that each patient deserves the same quality of care you'd desire for a loved one, chances are you'll take every precaution to prevent careless mistakes.

2. Recognize the chain of command. Suppose concerns arise during a case, such as the surgery not going as planned or the surgeon being unable to handle an unexpected complication. Who provides the next level of care? Do you contact another surgeon? Perhaps the charge nurse? Maybe the chief of surgery? In the event that you need to alert the proper authorities in your facility, don't waste time searching for the right person to inform. Knowing the chain of command can prevent a vital time sink. More importantly, not knowing this information could put you at risk for litigation.

3. Follow policies and procedures. In addition to following your facility's policies and procedures, make sure there's no ambiguity regarding the meaning of each procedure. Every course of action should be clear and certain, and should reflect the current standard of care for your service area. If you're hazy or you feel the policy is inconsistent with the care provided or with the standard of care, address this with your supervisor or risk manager at once. Following the rules will show that you're upholding your facility's guidelines.

4. Realize the scope of practice. Laws marking the legal boundaries of patient care and the scope of an RN's permitted responsibilities can vary significantly based on your location. For example, the Washington State Nursing Guide states that you must be a RNFA to perform activities involved in first assisting, which includes providing hemostats, handling tissue and suturing.

The perioperative RN's job is to plan, direct and coordinate. Keep in mind that you're ultimately responsible for the safe and correct performance and completion of assigned nursing tasks. The supervision of allied healthcare providers and support personnel, such as surgical technologists and certified nursing assistants, falls under this umbrella of accountability. This means that you, as the licensed personnel in the OR, are ultimately responsible for the patient care provided by the unlicensed personnel in the room.

5. Provide detailed and accurate documentation. If you did it, but didn't document it, then it will appear in the medical records as incomplete. Medical records should reflect in precise and detailed documentation the patient's care and the competence in providing it. If injuries or complications occur, detailed documentation will illustrate that you've assessed, planned, implemented and evaluated the care given in each case. Document in accordance with your facility's policies and procedures. Don't forget to sign, date and time all completed documentation and write legibly so any consecutive care providers can read it. Accurate and detailed documentation could be your best defense.

6. Meet the standard of care. This is defined as the degree of care, skill and learning a level-headed and practical healthcare provider should exercise under the same, or similar, circumstances. Striving to meet your facility's standards will keep you within your professional guidelines.

Know the elements of negligence. The anatomy of a professional negligence case has four elements, each of which must be established.

• Duty. You must have an established duty to the patient. A relationship must be recognized between you, as a healthcare provider, and the patient.
• Breach of duty. The failure to do what a rational and practical person would have done in the same or similar circumstances. For instance, deviation from a standard of care would be breaching your duty to the patient.
• Damages. The patient must have suffered economic or non-economic damages. Economic damages are those such as patient injury, leading to medical expenses, lost wages and earning capacity. Non-economic damages cause other consequences to the patient's health, including pain and suffering, and loss of companionship or affection.
• Causation. There has to be a reasonable connection between the act of negligence and the alleged damages. A cause-and-effect relationship must be shown between the breach of duty/negligence and the damages/injury the patient suffers.

For a successful case, the plaintiff must prove each of the four points above, by a preponderance of evidence. This would mean that the actions of the professional (her negligence or breach of duty) "more likely than not" caused the resulting damages to the defendant.

Listen to your intuition
Consider this situation: A surgical nurse scrubs in to assist a hand surgeon repairing a wrist fracture. During the procedure, the surgeon struggles to reduce the bone with a small bone clamp. Both his hands become occupied holding down the clamp and wrist. The nurse's assistance is necessary. The surgeon asks her to drill a wire into the area where the wrist fracture has been reduced. Should she:

a) load up the drill and do as instructed?
b) request that he drill while she holds the bone clamp? or
c) tell the physician it's out of her scope of practice to drill because she's not an assistant and suggest another solution?

Choice A is out of her scope of practice and may put her at risk for malpractice. Choice B is an acceptable answer, depending on the situation. However, choice C will ensure that she's staying within the scope of her duties and keep her protected from malpractice.